New paging system is as easy as 1-2-3

— Photo: Alex Munter, CEO, Dr. Jimin Lee, pediatric resident, and Connor McLean, quality improvement advisor. —

It’s 1:30 am and Dr. Jimin Lee, a CHEO pediatric resident, is in the Emergency Department gathering a history from a six-year-old boy and his parents about his asthma and doing a physical exam. The child will need to be admitted to the hospital. He is anxious about staying in the hospital and the parents have many questions. Dr. Lee is explaining what his stay at CHEO will look like and how we would help him get through it.

Then, Dr. Lee’s pager goes off, beeping loudly — she is needed on 4 East. Does she stay in the patient room in the Emergency Department to finish this conversation or does she step out to answer the pager?

This scenario is common.

Resident pediatric doctors spend nights responding to various requests throughout the hospital. When a life is at stake, the resident is called “stat” and drops everything that they are doing to respond immediately to this crisis. This system has always existed. But, for situations which are not life-threatening, resident doctors had no way to determine the urgency of the request through a pager.

Dr. Lee and her colleague Dr. Tejas Desai, another pediatric resident, found this sort of thing happening frequently. They would be engaged in caring for a child in one unit and get called away to another. Sometimes, this new request was urgent and the right thing to do was respond immediately but other times it was for a routine administrative matter and could be left until a quiet moment later that night.

Inspired by the desire to ensure that every child and youth gets the right treatment at the right time, Drs. Lee and Desai sought a simple solution. In consultation with nursing colleagues and Connor McLean, an efficiency expert on CHEO’s Quality Improvement Team, they developed a paging-priority system.

The new part of the paging-priority system is designed to assist resident doctors ensure that they are responding to all requests in the correct order and addressing the most pressing medical concerns first. The nurse who pages the doctor assigns a priority in accordance with the child’s need.

If there is a situation which is not life-threatening but requires urgent attention, like a child who is suddenly experiencing a lot of pain, this is assigned priority 1. The physician is needed in the next five to 10 minutes.

If the situation needs attention but can wait a little, like a child whose condition is stable but has a low resting heart rate while sleeping, this is assigned priority 2. The physician is needed in the next 15 to 30 minutes.

Finally, if the situation is routine and can be left until the resident doctor does not have other tasks, this is assigned priority 3.

Now, when Dr. Lee is at the bedside of a six-year-old boy in the middle of an admission and her pager goes off she can glance at it, note that it’s a priority 2 and be confident that she has time to carefully finish what she is doing before responding to the next request. Resident doctors are making more efficient use of their time, ensuring inpatient children and youth are getting the care they need, when they need it.